Patel Lopa, Teklay Samuel, Wallace David, Skillman Joanna
Plastic Surgery and Burns, University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK.
Burns and Plastics, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
BMJ Case Rep. 2018 Jun 27;2018:bcr-2017-219412. doi: 10.1136/bcr-2017-219412.
A 69-year-old man was admitted with non-resolving right leg cellulitis. Subsequent skin changes over the calf and discharging pus suggested necrotising fasciitis. After several wound debridements of the leg and imaging, the patient was found to have an iliopsoas abscess due to a metastatic perforated caecal tumour extending along the medial thigh to the calf. No micro-organisms indicative of typical necrotising fasciitis were isolated from the wound. The patient had an ileocaecal resection, and his leg was reconstructed with a split thickness skin graft. He continues to do well postoperatively. This case highlights key lessons when dealing with an unusual presentation leading to challenges in diagnosis such as: (1) the need for good interspecialty liaison, (2) prompt senior review and plan, and (3) 'thinking outside the box' when faced with a diagnostic challenge.
一名69岁男性因右下肢蜂窝织炎经久不愈入院。随后小腿部皮肤出现变化并伴有脓性分泌物，提示为坏死性筋膜炎。在对腿部进行多次伤口清创及影像学检查后，发现患者因转移性盲肠穿孔肿瘤沿大腿内侧延伸至小腿，导致髂腰肌脓肿。伤口未分离出提示典型坏死性筋膜炎的微生物。患者接受了回盲部切除术，腿部采用中厚皮片移植进行重建。术后恢复良好。该病例凸显了在处理导致诊断困难的不寻常表现时的关键经验教训，如：（1）需要良好的跨专业协作；（2）及时进行上级医师会诊并制定治疗方案；（3）面对诊断挑战时要“跳出框框思考”。
